Spread of awareness of COVID-19 between December 2019 and March 2020 in France

During the early phase of outbreaks, awareness of the presence of the disease plays an important role in transmission dynamics. To investigate the processes of how people become aware of a disease, we conducted two complementary investigations. First, we surveyed 868 academic researchers in France, on the time and circumstances when they became aware of COVID-19 as an important event. We found that 25% did so before February 18th (first death in France), 50% did so before March 10th (first presidential allocution) and 75% did so before March 16th (announcement of the lockdown). Awareness came from nine categories of circumstances: (1) decisions taken by the government (elicited by 35.7% participants); (2) information from media or social media (24.7%); (3) conversation with friends (22.4%); (4) observed changes in their personal lives (14.0%); (5) decisions taken by the employer (9.2%); (6) observed changes at work (9.9%); (7) suspected case of COVID-19 in their entourage (3.1%); (8) fear for oneself or their entourage (2.8%) and (9) self-appraisal of scientific reports (2.8%). Second, we appraised three general media in France (a television news show, a radio news show, and a newspaper) and showed that COVID-19 became a preeminent topic only after March 1st 2020 when the epidemic is present on national soil. Our results show that multiple intricated factors prompt the awareness of an emerging infectious disease. Awareness is not solely driven by general media as they begin to focus on the topic late.

Healthcare professional (n = 811)-n (%) 49 (6.0) www.nature.com/scientificreports/"[…] The major outbreak in Italy made it certain that COVID would create a global pandemic with extreme disruption to world economies and the need for local closures of one kind or another.In early March, we [me and my family] decided to move to our remote chalet in the Alps.On March 10th, I announced my students that I would be experimenting distance learning over the next few weeks." (69 year-old male head of laboratory in Mathematics) "At first, I didn't take the epidemic seriously, despite concerns from my loved ones were concerned.I realized that the pandemic was going to have an important impact on my life when the lockdown was announced in France" (26 year-old male student in Chemical Engineering) Circumstances during which participants realized that COVID-19 would disrupt their individual lives were captured using a broad open-ended question "Do you remember the circumstances (discussion with others, information received, particular event, etc.) during which you realized that the COVID-19 epidemic was an important event in your life?".Answers represented a corpus of 185 000 words.Thematic analysis by HB, ERB, NV and VTT led to the identification of nine overarching categories of circumstances during which individuals became aware of COVID-19 as an important event in their lives (Table 2).
Three were often associated with an earlier awareness of the disease: (1) information delivered by media or social media (elicited by 24.7% participants); (2) conversation with colleagues or friends (22.4%); (3) selfexpertise and/or appraisal of scientific reports (2.8%) (Fig. 1).For example, participants who reported having realized the importance of the COVID-19 pandemic from media and social media were, on average, aware of the disease about 1 month earlier than those who realized this from observed changes in their personal lives.Furthermore, the 21 (2.5%) participants who reported becoming aware of the pandemic from personal contacts with people from China or Italy were often aware of COVID-19 earlier than other respondents (50% before February 24th, and 75% before March 1st).
"I was on vacation in Singapore in February 2020.I became aware of the magnitude of the pandemic that was coming in view of the precautions taken from Singaporean authorities (disinfection of the subways, taking temperatures in hotels, airports, museums, closing the borders to flights from China from the beginning of February...)" (60 year-old female researcher in Biology) The six others were often associated with later awareness of the disease: (1) decisions taken by the government (35.7%);(2) decisions taken by employer and/or university (9.2%); (3) observed changes in their personal lives (14.0%); (4) observed changes at work (9.9%); (5) suspected case of COVID-19 (personal or in their entourage) (3.1%); and (6) fear for oneself or their entourage (2.8%).
[I realized that COVID-19 was an important event…] "When a scientific event I was attending was cancelled to avoid large gatherings.It was the first time Covid had a direct impact on my life.It was all the more unexpected as the event, planned over 2 days, had taken place the day before but was suddenly cancelled during the second day.Before that, Covid was only a hearsay for me." (25 year old female master's student in Social sciences) Many participants also reported that awareness came gradually, in several steps.Often, these participants reported the lockdown as the time when they realized the importance of the epidemic despite being "aware" earlier.
"The impression that Covid was becoming an important event in our lives came gradually.But a turning point was marked in about a week when the internships abroad were cancelled by the university, the confinement in Italy and the wave of deaths in Bergamo." (25 year-old male student in Chemistry) Furthermore, participants' answers highlight that awareness of the disease did not automatically result in actions.In fact, only few participants reported enacting changes in their activities by themselves.
"My wife is Italian and my in-laws live in Italy.I could see the epidemic growing there and the denial here.Two weeks before the lockdown, I started moving around exclusively by bike." (38 year-old male doctoral student in Social sciences) Finally, when asked whether participants also anticipated the impact of COVID-19 on society, most participants (n = 626, 72.1%) had not imagined the impact it could have had on society."I was in disbelief.I thought it would be just "a bad and slightly more virulent flu"." (41 year-old male researcher in Physics) Of note, while some participants anticipated the impact on society, they did not realize the importance of COVID-19 in their lives until public health interventions were imposed by governing authorities.
""I realized that the COVID-19 outbreak was going to have an impact on my personal life on March 15, when there were rumors about a potential lockdown.Until then, I felt that COVID was an important event in world history, but the outbreak had not yet impacted my life."»(59 year-old male researcher in Computer Sciences)

Media appraisal investigating the evolution of the pre-eminence of COVID-19 in comparison to other topics, over time in a newspaper, a television and a radio show
We compared the time when academic researchers became aware of COVID-19 as an important event in their lives and the evolution of the pre-eminence of COVID-19 in the general media, in France.www.nature.com/scientificreports/A single investigator (HB) appraised the evolution of the pre-eminence of COVID-19 in comparison to other topics, over time, in three general media sources: (1) the daily national newspaper "Le Monde ", which is one of the French newspapers of record; (2) the evening news "Journal de 20 h" from "France 2", which is one of the main public French television (TV) show; and 3) the morning news "Journal de 8 h" from "France Inter", which is one of the public radio news show with the largest audience in France.
In total, we extracted 820 articles from "Le Monde" related to COVID-19.Two articles were published between the 1st of January and the 15th of January whereas 67 articles were published in one day, on March 16th.Besides the increase in the number of articles related to COVID-19, we observed a spill over in all areas of society from Economy to Sports (e.g., cancellation of cultural or sport events).In Fig. 2A, February 22nd, just after the lockdown in Italy, marks the timepoint after which almost all sections of the newspaper are related to COVID-19.
In the evening news, we appraised 30 broadcasts selected at random from December 2, 2019 to March 17, 2020.In our sample, the first mention to COVID-19 was about concerns about the evolution of COVID-19 during the Chinese New Year (January 20th).Similar to the newspaper, Fig. 2B we observed a rapid increase in the number of mentions to COVID-19 starting from the end of February.In general, the evening news involves about 10-15 segments on various topics, meaning that starting from March 1st, almost all the broadcast was dedicated to COVID-19.
In the radio morning news, we appraised 30 broadcasts selected at random from December 2, 2019 to March 17, 2020.In our sample, the first mention of COVID-19 was on January 22nd after an emergency meeting of the World Health Organization.Similar to the other media, Fig. 2C shows a rapid increase in the number of mentions to COVID-19 starting from the end of February.After March 12th and 13th, over half of the morning news time was dedicated to COVID-19.
Overall, we observed a similar trend in all three media, COVID-19 was (1) rarely mentioned prior to January 2020; (2) regularly mentioned from January 15th to March 1st with about 20% of the topics and time of TV and radio shows dedicated to the subject; and (3) became the most preeminent topic discussed in all three media, with a spill over in all areas of society after March 1st.

Discussion
In this mixed methods study, we appraised the time and circumstances during which academic researchers realized that COVID-19 was an important event in their lives and society.In particular, we showed that awareness came from nine categories of circumstances: (1) decisions taken by the government; (2) information from media or social media; (3) conversation with friends; (4) observed changes in their personal lives; (5) decisions taken by the employer; ( 6) observed changes at work; (7) suspected case of COVID-19 in their entourage; (8) fear for oneself or their entourage and (9) self-appraisal of scientific reports.
During the analysis of qualitative data from this study, we also found that awareness of an epidemic is a progressive process with three stages: first participants "heard" of COVID-19 and/or followed news from China without believing that the epidemic could become their reality.Exposition to information was "passive" at that stage.Second, participants realized that the epidemic was closer with the first cases in France and the Italian lockdown.They often became "active" in their search of information and began to worry.Finally, they became aware that COVID-19 was going to be an important event in their lives when the lockdown became "inevitable" in France.We hypothesize that situations encountered gradually transform of our vision of the world: uncertainties take shape and our ways of sensing the what is at stake changes, especially as the impact become tangible in the close environment.
Interestingly, our results show a similar trend in the time when media become "interested" in COVID-19, in France and in China.One study using data from social media in China showed that before January 19th 2020, there was little information online about COVID-19, with an exponential increase in the number posts and comments from January 19th to January 26th 2020 9 .Similar, our data shows that COVID-19 was not mentioned before January 19th in French media, although the epidemic was notable in China at that time.This contrasts with the following massive "infodemic" which made it difficult for scientists and governments to communicate and spread information to citizens.In all, early communication is critical to spread awareness.Afterwards, the cacophony of mis-or event disinformation ("fake news") may mitigate the efficacy of communication, disease awareness and health behaviours.
Our study has several limitations.Regarding the survey, it is retrospective and may be affected by memory bias.To minimize memory bias, we asked respondents to use agendas, mails and text messages when answering the questionnaire.Yet, in our data, we observe that most participants provided precise dates and circumstances, suggesting that they usually remember a "turning point" when they realized the importance of the pandemic.Second, our population is not representative of academic researchers in France.We tried to mitigate selection bias by opting systematically contacting all doctoral schools, in France.However, only willing researchers participated in the survey.Furthermore, we did not make any reminder invitation mails, to avoid spamming researchers.Despite these limitations, our results show that our sample was diverse, covering all disciplines and seniority levels, from PhD students to head of laboratories.Third, although the questionnaire was developed from qualitative interviews with questions and wording developed so as to provide the most meaningful answer, we did not pilot test it in its final form.
Regarding the media analysis, we selected two were public media and may have similar editorial policies.Second, we chose a limited number of time points, lowering the precision of the evolution curve.Finally, analysis was performed by a single investigator.
To conclude, as some participants reported that the awareness of an emerging epidemic disease led them to take actions in their personal lives or in their laboratory, we may want to consider the process of awareness of an emerging epidemic disease as leading to a "turning point" during which our appraisal of the world changes 11 .
As Abbott points out, our appraisal of the world and our social interactions are part of a permanent construction based on multiple factors 12 .A turning point is a process that intervenes in a network of established and ongoing interactions within which emerge new orientations.It is a long-term process and has two key points: possibility and action.In early 2020, it was potentially feasible (the possibility) for a pandemic to affect participants.But it only became real when it effectively transformed their daily lives (the action).The turning point is contingent insofar as the outcome depends on the sequence of these internal events.And it is these events that www.nature.com/scientificreports/ a cross-methodology, such as the one we proposed, may be able to describe.The heuristic interest of the notion of turning point is therefore based on its situated and procedural character.These first results lead us to wonder about the outcome of this long-term process and to what extent we are still in the process of turning point initiated by the pandemic.

Conclusion
Academic researchers who reported realizing the importance of COVID-19 from media and social media became, on average, aware of the disease about 1 month earlier than those who realized this from observed changes in their lives (often linked to governmental decisions).In parallel, we show that COVID-19 became a preeminent topic in the French general media only after March 1st 2020.These combined results hint that public institutions willing to accelerate the spread of awareness of an emerging disease abroad, may want to implement a massive media strategy early.Second, our results also show that awareness seems to be directly related to visible changes in peoples' lives (i.e., cases in their entourage, decisions from their employers, decisions from the government); implying that response to an emerging infectious disease must be rapid and visible, so as to prompt awareness and modify behaviour that may prevent the epidemic.

Materials and methods
This study involved two complementary parts.First, we surveyed academic researchers' perception on when they realized that COVID-19 pandemic was an important event in their lives and for society.Second, we appraised of the evolution of the pre-eminence of COVID-19 over other topics in the media.All methods were carried out in accordance with relevant guidelines and regulations.
The study is a social science study and does not require Ethical approval before its conduct (https:// www.legif rance.gouv.fr/ jorf/ id/ JORFT EXT00 00254 41587/-French law).As such, it does not require written informed consent from subjects.All participants were informed of the study objectives, modes of data collection and analysis methods before participating and provided electronic consent before filling the questionnaire.

Online survey investigating when and how did academic researchers become aware of COVID-19 as an important event in their lives and for the society
We surveyed academic researchers' perception on the time and circumstances during which they realized that the COVID-19 pandemic could represent an important event in their lives and for society.We focused on this population because academics are often key in counselling decision-makers in face of unpredictable events with severe consequences.
Participants were academic researchers (master, PhD students, postdoctoral fellows and tenured researchers), in France, recruited by a mail invitation sent to the 275 doctoral schools in France 13 .They were invited to connect on a secured website to answer a single online questionnaire, in March 2022.We chose to focus on this population because they are often key in counselling decision-makers in face of unpredictable with severe consequences.Participants who had been invited were encouraged to invite relatives and friends who were eligible to participate, by a 'snowball' sampling method which involves identifying an initial number of participants who serve as 'seeds' to help identify peers who, in turn, are asked to invite others and so forth 14 .
The questionnaire was designed from 10 face-to-face interviews with participants following methods recommended to develop participant reported measurement tools 15 .This approach helped us understand which questions and words prompted the most meaningful answers from participants.Furthermore, the open-ended interviews helped in the definition of the constructs to be addressed-particularly, around the concept of "turning point".The questionnaire started with a graphical representation of major events that occurred from December 2019 to March 2020 (e.g., first case of COVID-19 in France, dates of presidential allocutions, etc.) to help respondents remember isolated events by making use of the interrelatedness of autobiographical experiences and to remobilize distant memory of facts which took place several months apart 16,17 .
Then, respondents were asked to describe the circumstances during which they realized that the COVID-19 pandemic was an important event in their lives and for society, using a broad open-ended question "Do you remember the circumstances (discussion with others, information received, particular event, etc.) during which you realized that the COVID-19 epidemic was an important event in your life?".Finally, respondents were asked to date this event.They were encouraged to use agendas, mails or messages from this period, to provide accurate dates.
Sample size was determined by our two objectives.First, we aimed at determining the time when academic researchers became aware of COVID-19 as an important event in their lives and for the society.As this objective was descriptive, a larger sample size would result in more precision.For that, we adopted a pragmatic approach and used the maximal sample feasible 18 .Second, the survey aimed at identifying the circumstances during which academic researchers became aware of COVID-19 using a qualitative approach.Simulation studies have shown that 150 participants and over are adequate for online surveys with open ended questions 19 .
Open-ended answers were analysed by four researchers (HB, EBR, NV and VTT) using thematic analysis.The analysis aimed at understanding the circumstances during which the Covid-19 pandemic became an "event" identified as such in a large population of academic researchers; it was therefore structured by constructs that could capture the transition between what happened "before" the pandemic and the emerging awareness that researchers were "in" the pandemic.First, the content collected through the semi-structured interviews was reviewed and refined to identify recurrent patterns of perceived "turning points"-constructed retrospectively by the researchers' accounts of the way they experienced the early days of the pandemic.Second, we used this knowledge to analyse the survey data in three steps.First, during an initial reading and coding of the 100 first respondents' answers, one researcher (HB) inductively coded the manifest content of the first 100 answers and identified "in vivo codes": literal terms used by participants to describe the circumstances during which they www.nature.com/scientificreports/realized the pandemic was an important event in their lives.Second, the researchers developed a list of categories by grouping the previously defined codes by similarity.Finally, one investigator (HB) assigned all remaining answers to the categories defined earlier.Whenever a new idea emerged, researchers discussed the idea, thereby refining and enriching the list of categories.We presented the cumulative number of participants who realized that the COVID-19 pandemic represented an important event in their lives, over time.Dates before December 2019 and after December 2021 were doubled checked using the open-ended answers to account for errors in years (e.g., often participants dated their awareness in 2021 while referring to the first lockdown in France).Whenever the open-ended text could not be used to appraise whether there was an entry error (n = 23), we considered the date as missing information.
Media appraisal investigating the evolution of the pre-eminence of COVID-19 in comparison to other topics, over time in a newspaper, a television and a radio show A single investigator (HB) appraised the evolution of the pre-eminence of COVID-19 in comparison to other topics, over time, in three general media sources: (1) the daily national newspaper "Le Monde", which is one of the French newspapers of record; (2) the evening news "Journal de 20 h" from "France 2", which is one of the main public French television news show; and (3) the morning news "Journal de 8 h" from "France Inter", which is one of the public radio news show with the largest audience in France.
In the daily national newspaper "Le Monde", the investigator searched the archives (available online at http:// www.lemon de.fr/ archi ves-du-monde) between the December 2, 2019 and March 17, 2020 for all articles that included the terms "coronavirus", "-ncov", "covid" or "virus" in the title or summary.Entries retrieved were screened to exclude irrelevant articles, for example on Ebola, Papilloma or Computer viruses.For each article we extracted its publication date, title, and summary as exhibited on the article's webpage.
For the evening news "Journal de 20 h" from "France 2", the investigator selected two random broadcasts every week, between the December 2, 2019 and March 17, 2020 (available online at http:// www.franc etvin fo.fr/ replay-jt/ france-2/ 20-heures).The investigator measured the time dedicated to any COVID-19 topic (in minutes) during the broadcast.In addition, he counted, for each broadcast, the number of topics related to COVID-19.
For the radio program "Journal de 8 h" from "France Inter", the investigator selected two random broadcasts every week between December 2, 2019 and March 13, 2020 (available online at http:// www.radio france.fr/ franc einter/ podca sts/ le-journ al-de-8h).The investigator measured the time dedicated to any COVID-19 topic (in minutes) during the broadcast.In addition, he counted, for each broadcast, the number of topics related to COVID-19.

Table 1 .
Participants' characteristics (n = 868).*This figure relates to physicians that do not have another position (e.g., who are not head of laboratory, tenured researchers, doctoral students, etc.).

Table 2 .
Circumstances during which participants became aware of COVID-19 as an important event in their lives (n = 845).
"I was coming back to Paris after a week in England.When I saw governmental posters about shielding measures, I realized that "it was really serious".Prevention was becoming systematic and had taken national dimension.The posters looked unusually totalitarian, and for good reason, it was all new for everyone and at the same time it was necessary to act."(Femalemaster'sstudent in History)302 (35.7)Information from general or social media "At the beginning of 2020, […] I spent nights reading "first hand" news from US and Asian websites, sensing that something worrying was happening[…].Just after New Year's Eve, around January 3rd, I remember I couldn't sleep at night and I searched for as many international sources as I could."(38-year-oldmalePhDstudent in social sciences) 209 (24.7)Conversation with colleagues or friends "I heard about {COVID-19] from a friend, in early January 2020.This friend had heard stories of an epidemic in China from her clients who belonged to high public functions.At that time, I was expecting a vaccination campaign like what we had seen for the bird flu.I realized the magnitude of the problem when the epidemic was reclassified as a pandemic."(25-year-oldfemalePhDstudentinmathematics)189(22.4)Observedchanges in their personal lives "We were waiting for friends at the restaurant.The owner told us that he was going to have to close p for an indefinite period by order of the Prime Minister.The streets seemed strangely empty to us and the city was silent.For me, awareness was long and gradual (…), but the last step taken which led to the acceptance was brutal and took place around the lockdown" (38-year-old male PhD student in biology) 118 (14.0)Decisions taken by employer and/or university "I was doing fieldwork for my Masters' internship when I got a call from my supervisor telling me to go home.The fieldwork was getting cancelled because of COVID.That's when I understood that things were serious" ("I live in Mulhouse and we were impacted earlier.Almost all the staff of my children's day care got sick.Then the children got sick.When I called the director, he told me that something strange was going on.Helicopters were flying over our house more and more often, day and night."(38-year-oldfemalePhDstudent in social sciences)26 (3.1)Self-expertise / appraisal of scientific reports "As a PhD student working on viral modifications, I started to read up on this emerging virus early[…].I became aware that what was happening was going to be important when I started noticing big contradictions between scientific facts and the official communication."(28-year-oldfemalePhDstudent in biology)24 (2.8)Fear for oneself or their entourage "At the retirement party of a colleague, a colleague whom I used to greet with a kiss refused to do so.That's when I realized that the epidemic was scaring people[…]and that it could change a lot of things in my relationships with others." (40-year-old female researcher in Earth sciences) 24 (2.8) Vol.:(0123456789) Scientific Reports | (2024) 14:6850 | https://doi.org/10.1038/s41598-024-56423-5